Hospital Safety.pdf

National Disaster
Management Guidelines
Hospital Safety

National Disaster Management Guidelines—Hospital Safety
A publication of:
National Disaster Management Authority
Government of India
NDMA Bhawan
A-1, Safdarjung Enclave
New Delhi – 110 029
ISBN : 978-93-84792-03-9 978-93-80440-13-2
February, 2016
When citing these guidelines the following citation should be used:
National Disaster Management Guidelines: Hospital Safety. A publication of the
National Disaster Management Authority, Government of India.
ISBN: 978-93-84792-03-9 978-93-80440-13-2
The National Disaster Management Guidelines on Hospital Safety are formulated by NDMA, in
consultation with various stakeholders, academic experts, subject specialists from across the
country and officials from concerned Ministries and Departments of Government of India.

National Disaster
Management Guidelines
Hospital Safety
National Disaster Management Authority
Government of India

Hospital Safety vii
Executive Summary v
Introduction 1
1.1 Hospitals and Disasters 1
1.2 Expected Disaster Scenarios for Hospitals 3
1.3 Safe Hospitals 3
About the Guidelines 5
2.1 Vision 5
2.2 Objective of the Guidelines 5
2.3 Scope of the Guidelines 5
2.4 Institutional Mechanisms 6
2.5 Implementation of the Guidelines 6
Awareness Generation for Hospital Safety 7
3.1 Scope 7
3.2 Communication Goals 7
3.3 Stakeholders/Target Group 8
3.4 Key Elements of Awareness Generation for Hospital Safety 8
3.5 Awareness Generation Exercises 10
Hospital Disaster Preparedness and Response 11
4.1 Scope 11
4.2 Coordination Management 12
4.3 Planning, Training and Drills 13
4.4 Information, Communication and Documentation 15
Contents

National Disaster Management Guidelines : Hospital Safety
Hospital Safety
viii
4.5 Safety and Security 18
4.6 Human Resources 19
4.7 Logistics, Supply and Finance Management 20
4.8 Continuity of Essential Support Services 21
4.9 Triage 23
4.10 Surge Capacity for Medical Response 24
4.11 Post-Disaster Recovery 26
4.12 Patient Handling 26
4.13 Volunteer Involvement and Management 27
4.14 Area Level Networking of Hospitals 28
4.15 Coordination and Collaboration with Wider Disaster Preparedness Initiatives 28
4.16 Hospital Disaster Management Plan with respect to CBRN Emergencies: 29
Design and Safety of Hospital Buildings 31
5.1 Scope 31
5.2 EXPECTED PERFORMANCE OF HOSPITALS 33
5.3 Design Standards 35
5.4 Structural Elements 35
5.5 Non-Structural Elements 42
5.6 Enabling Environment Towards Ensuring Hospital Safety 52
5.7 Miscellaneous 54
5.8 Capacity Building 54
Fire Safety in Hospitals 57
6.1. Scope 57
6.2 Expected Levels Of Fire Safety In Hospitals 57
6.3 Structural Elements of Fire Safety 58
6.4 Non-Structural Elements of Fire Safety 68

Hospital Safety ix
Contents
Maintenance and Inspection for Safe Hospitals 71
7.1 Maintenance and Inspection 71
7.2 Maintenance of Occupational and Functional Components 72
7.3 The Maintenance Policy Plan 73
7.4 Maintenance of Structural Systems 73
7.5 Inspection of Structural Components 74
7.6 Inspection of Occupational and Functional Components 74
Licensing and Accreditation 77
8.1 Scope 77
8.2 Important Definitions 77
8.3 Licensing Requirements 79
8.4 Accreditation Requirements 81
National Action Framework for Hospital Safety 85
9.1 Scope 85
9.2 Priority Areas and Outcomes 85
Annexures
Annexures – 1 101
Annexures – 2 104
Annexures – 3 107
Annexures – 4 110
Annexures – 5 112
Annexures – 6 114
Annexures – 7 115

Hospital Safety xi
The guidelines on Hospital Safety have been developed with the vision that all hospitals in India will be
structurally and functionally safer from disasters, such that the risks to human life and infrastructure
are minimized.
The overall aim of the guidelines is to mainstream disaster prevention, mitigation, preparedness and
response activities into the health sector in our country, with specific focus on hospitals; such that
hospitals are not just better prepared but fully functional immediately after disasters and are able to
respond without any delay to the medical requirements of the affected community.
The first chapter introduces the need and importance of hospital safety and risk resilience in today’s
times.
The second chapter focuses upon the key objectives of the said guidelines as mentioned below:
(1) To address hospital safety through a multi-hazard and inter-disciplinary approach;
(2) To ensure structural safety of hospitals (especially of critical facilities);
(3) To ensure that all professionals involved in the day to day operation of hospitals are
prepared to respond to disasters; and,
(4) To ensure that every hospital in the country has a fully functional and regularly tested
Hospital Disaster Management Plan
The third chapter deals with awareness generation activities for hospital safety with an aim to sensitize
the key stakeholders and community on the need for disaster management in health facilities and to
achieve the overall aim of protecting the lives of patients and health workers by ensuring the structural
resilience of health facilities as well as improving the risk reduction capacity of health workers and
institutions.
The fourth chapter on hospital preparedness and response focuses upon provisions required to be put
in place to ensure functional safety of hospitals/health facilities in disaster situations. The provisions
laid down are the minimum required standards that shall be adhered to by all healthcare facilities; and
address both internal and external disasters that are likely to affect hospitals. The chapter lays stress
upon the key objective of disaster preparedness and response for hospitals/healthcare institutions
which is to ensure that they can remain functional and continue providing the necessary health care
services during and immediately after an emergency.
Executive Summary

The fifth and sixth chapter focus upon the structural and design safety elements as well as fire
safety pertaining to hospital. The seventh chapter throws light on the elements pertaining to regular
maintenance and inspection for hospitals. The eight chapter provides an overview of the standard
Licensing and Accreditation requirements that shall be followed by hospitals to ensure disaster
preparedness. Conscious efforts need to be made to achieve the goal of ‘safer and functional hospitals’
in the country at the earliest; and towards this end, the ninth chapter lays down the ‘National Action
Framework for Hospital Safety’, as a focused strategy which should be followed to achieve this goal.
This guideline has been formulated to ensure that when implemented at all levels, the risks to human
life and infrastructure are minimised; and hospitals are not only better prepared but are optimally
functional immediately after disastrous events, such that they are able to respond immediately to the
medical requirements of the affected community.
It is strongly recommended that the interventions suggested in this guideline are approached and
implemented in a systematic and time bound manner, since disastrous events can happen anytime,
anywhere and at any scale.

Hospital Safety 1
1.1 Hospitals and Disasters
Disasters have an uncanny ability to bring to the forefront vulnerabilities of systems, structures,
processes and people which in turn cause large scale damages; and hospitals are no exception
to this rule.
In India, experiences from the Gujarat earthquake of 2001, the Indian Ocean Tsunami of 2004
and the Kashmir Earthquake of 2005 have shown that disasters affect not only the population
but also health facilities. Particularly when the Children’s Hospital in Jammu collapsed; in the
city of Bhuj, where thousands of people died and the civil hospital was reduced to a heap of
debris when it was needed the most. The fire in AMRI Hospital in Kolkata, where more than
90 people died, reminded us that it is not simply the structural resilience but also operational
resilience of hospitals that needs to be addressed, if we wish to reduce the impact of disasters
on hospitals.
Both these instances of the civil hospital collapsing in Bhuj and the fire in AMRI Hospital in
Kolkata, provided evidence based lessons of the underlying vulnerabilities that cause hospitals
to get affected by disasters, which may be broadly grouped as follows:
• Inadequate or non- compliance of structural elements of hospitals to building codes
and other safety norms which result in the failure of hospital structures and their
component non-structural elements;
• Absence of an operational Hospital Disaster Management Plan;
• Lack of planning and preparedness to respond to disasters;
• Inadequate or complete lack of internal and external communication; and
• Lack of networking amongst hospitals.
As a result, when hospitals are affected by disasters, the repercussions are three dimensional
– health, social and economic.
Introduction
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Hospital Safety
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The health impact of hospitals being affected by disasters include, other than the very obvious
lapses in medical care being provided to victims of a disaster, lapses in preventive medicine
and public health response. This is because hospitals host laboratories and can contribute to
the diagnoses and issuance of warnings of imminent communicable diseases that may spread
post a disaster.
The social impact of hospitals being affected by disasters includes a loss of confidence/morale
in the affected community which can affect the long-term recovery and sense of well-being of
the community. The economic impact of hospitals being affected by disasters is a little more
obvious, given the enormous investments required to be made to construct hospitals and the
expensive equipment that is lost when disasters strike hospitals. Even the use of temporary
field hospitals as a contingency measure is economically unviable. It is an attested fact that the
costs involved to mitigate and prepare hospitals for disasters are far less than those required
for re-building hospitals after they have been damaged by disasters.
Link 1: Excerpts from the National Policy on Disaster Management 2009 on Medical
Preparedness and Mass Casualty Management (page 20 – Chapter 5 – Disaster Prevention,
Mitigation and Preparedness)
5.2.8 Medical preparedness is a crucial component of any DM Plan. The NDMA, in close
coordination with the Ministry of Health and Family Welfare, States and premier medical
research institutes will formulate policy guidelines to enhance capacity in emergency medical
response and mass casualty management. DM plans for hospitals will include developing
and training of medical teams and paramedics, capacity building, trauma and psychosocial
care, mass casualty management and triage. The surge and casualty handling capacity of all
hospitals at the time of disasters, will be worked out and recorded through a consultative
process, by all the States/UTs in the pre- disaster phase.....
Link 2: Hospital Disaster Preparedness: (Excerpts from National Disaster Management
Guidelines on Medical Preparedness and Mass Casualty Management)
Hospitalsareanimportantunitforthemanagementofmasscasualties.Hospitalpreparedness
in the pre- disaster phase enhances the effectiveness of their coordinated response during
disaster situations. In India, there are different hospitals under different administrative
setups. The availability and quality of medical facilities differ drastically from urban to rural
and from private to governmental hospitals. Thus, preparedness calls for hospital disaster
management planning at the hospital level, its development and up-gradation, planning at
district /state level and overall regional plans for effective management.

Introduction
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Hospital Safety
1.2 Expected Disaster Scenarios for Hospitals
Hospitals may face both internal and external disasters. The impact of internal disasters such
as fire, exposure to hazardous material, utility failures, etc., is typically limited to the hospital/
healthcare facility while external disasters include scenarios such as earthquakes, mass casualty
events or epidemics where the hospital itself may or may not be affected but is a critical part
of the larger response. As such three scenarios can be expected when disasters strike. They
are as follows:
(1) Community Affected – Hospital Unaffected: During such scenarios, hospitals play a vital
role in the larger disaster response being undertaken. For hospitals such scenarios would
implyasuddenincreaseindemandbecauseofthesurgeinthenumberofpatientsseeking
medical attention. There is a possibility of the hospital facility getting overwhelmed if
adequate preparedness and response mechanisms are not swung into action as soon
as the disaster occurs.
(2) Community Unaffected – Hospital Affected: Such scenarios arise from the internal crises/
emergencies of hospitals. As such, partial or complete evacuation and transfer of critical
patients to networked hospitals is the key to successful response. Such scenarios also
demand a high degree of preparedness on the side of the hospital administration and
staff, as well as a speedy response from the surrounding community and hospitals.
(3) CommunityAffected–HospitalAffected:Suchsituationsexacerbatethechallengesposed
to hospitals, as they not only need to cater to the existing demand on their facilities but
also need to address the sudden increase in demand on their facilities because of the
surrounding community being affected by disasters. In such situations the hospitals may
even find themselves facing the added challenges of loss of essential services, like water
supply, electricity, medical gases, etc. and a reduction in man-hours per patient.
Hence, the only rational manner in which hospitals can be prepared for disasters is by
increasing their resilience and reducing their vulnerability; by strengthening both structural and
operational aspects of the hospital, such that they achieve a reasonable degree of safety.
1.3 Safe Hospitals
The Pan American Health Organization (PAHO) and the World Health Organisation (WHO) have
defined: “a Safe Hospital as one that:
• will not collapse in disasters, killing patients and staff;
• can continue to function and provide its services as a critical community facility
when it is most needed; and,

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• is organised, with contingency plans in place and health workforce trained to keep
the network operational.”
The concept of safe hospitals does not merely refer to the physical and functional integrity of
health facilities but also the preparation to function at full capacity and cater to the needs of
the affected community immediately after disaster strikes.
Thus, making hospitals safe involves understanding and mitigating factors that contribute
to their vulnerability during an emergency or disaster such as the building’s location, design
specifications and materials used, damage due to non-structural elements, untrained
professionals and lack of basic understanding of disaster management. Critical services such
as electricity, water and sanitation, waste treatment and disposal of medical wastes are
important to ensure continuity of operations during an emergency situation. The importance
of hospitals and all types of health facilities extend beyond the direct life-saving role they play.
Therefore, special attention must be given to ensure that hospitals are structurally safe and
health professionals are sensitized, oriented and trained to handle emergency conditions.

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Hospital Safety
2.1 Vision
The guidelines on Hospital Safety have been developed with the vision that all hospitals in
India will be structurally and functionally safer from disasters, such that the risks to human
life and infrastructure are minimized.
Theoverall aim of theguidelines is to mainstream disasterprevention,mitigation,preparedness
and response activities into the health sector in our country, with specific focus on hospitals;
such that hospitals are not just better prepared but fully functional immediately after disasters
and are able to respond without any delay to the medical requirements of the affected
community.
2.2 Objective of the Guidelines
The key objectives of the guidelines are:
(1) To address hospital safety through a multi-hazard and inter-disciplinary
approach;
(2) To ensure structural safety of hospitals (especially of critical facilities);
(3) To ensure that all professionals involved in the day to day operation of hospitals
are prepared to respond to disasters; and,
(4) To ensure that every hospital in the country has a fully functional and regularly
tested Hospital Disaster Management Plan.
2.3 Scope of the Guidelines
Health Care in India is categorized into three categories – primary, secondary and tertiary,
whereby Sub-Centres and Primary Health Centres (PHCs) fall under the primary level,
Community Health Centres (CHCs), Sub-District/ Sub-Divisional Hospitals and District Hospitals
About the Guidelines
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Hospital Safety
fall under the secondary level and Multi-Super Specialty Care Hospitals fall under the Tertiary
level. The provisions laid down in this guideline shall be applicable to all healthcare facilities in
the government sector and their equivalent counterparts in the private sector. Smaller facilities
may choose to adapt relevant sections of the guidelines to address disaster management
concerns as per their context and local conditions.
2.4 Institutional Mechanisms
Both Health and Disaster Management being state subjects, it implies that the respective state
health departments and state disaster management authorities, along with the state public
works department, will play a crucial role in implementing these guidelines on the ground.
However, the Ministry of Health and Family Welfare, the Central Public Works Department
and other licensing agencies at the Central or State levels will also undertake the necessary
actions to implement these guidelines for effective compliance.
Wherever necessary, the National Disaster Management Authority, the Bureau of Indian
Standards, technical institutions like IITs and other relevant agencies shall extend their support
to further the agenda of Hospital Safety in our country.
2.5 Implementation of the Guidelines
Some of the provisions for hospital safety that have been detailed in these guidelines can be
undertaken with immediate effect, while some others may require a considerable amount of
timeforpolicydecisions,preparationandimplementation.Hencetoaddresstheimplementation
of Hospital Safety activities in the country, a detailed National Action Framework has been
developed as a part of these guidelines which outlines short term (1 to 5 years), medium term
(5 to 10 years) and long term (more than 10 but within 20 years) goals for implementation.

Hospital Safety 7
3.1 Scope
The first step towards making hospitals safe is to create awareness among various stakeholders
about the need to have safe hospitals, what it entails and actions that can be undertaken.
Allawarenessgenerationactivitiesforhospitalsafetyshallaimatsensitizingthekeystakeholders
and community on the need for disaster management in health facilities and to achieve the
overall aim of protecting the lives of patients and health workers by ensuring the structural
resilience of health facilities as well as improving the risk reduction capacity of health workers
and institutions.
The key objectives of awareness generation activities for Hospital Safety shall be:
(1) Spreading awareness on protecting critical health facilities from disasters by
including risk reduction in the design and construction of all new health facilities,
and by reducing vulnerability in existing health facilities through structural and
non-structural measures.
(2) Sensitizing the health workforce in hospitals as they are central to identifying
potential health risks from natural hazards.
This Chapter shall focus on the approach that needs to be taken for awareness generation
activities to create an environment in which all relevant stakeholders are well aware of and
readily support the various actions that need to be taken to make hospitals safe.
3.2 Communication Goals
The key goals of all awareness generation activities shall be:
(1) To create an enabling environment and momentum to generate strong interest in
hospital safety
(2) Inform the health institutions and its workforce about emergency management,
dos and don’ts and linkages between disaster management and hospital safety
Awareness Generation for
Hospital Safety
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Hospital Safety
(3) Raise awareness that health facilities should be prepared to deal with emergencies
that arise due to disasters both natural and human induced.
3.3 Stakeholders/Target Group
The primary, secondary and tertiary target groups identified for awareness generation on
hospital safety are as mentioned below:
3.3.1 Primary Target Group
(1) Hospital Staff/Administration
(2) Doctors/Nurses/Paramedical staff as they provide support towards critical services
in hospitals
(3) Policy makers, as they are responsible for taking key decisions and can bring about
necessary interventions required for hospital safety
3.3.2 Secondary Target Group
(1) Students, studyingin medical/public health colleges as theycan beeffectivechange
agents. If they are aware, they can implement those learning’s to make health
facilities safer
(2) Architects, engineers and masons to ensure safe structures (hazard resistant
construction with respect to health facilities)
(3) Media professionals, media plays a critical role in influencing community as well
as policy makers.
(4) Financial institutions such as banks and other lending agencies that can finance
the construction, reconstruction or retrofitting of health facilities
3.3.3 Tertiary Target Group
(1) Community members are the beneficiaries. It is the community that gets first
affected during disasters and they need a safe place where they can be treated
and provided with other health facilities. Also, community members play a crucial
role of first responders during any disaster.
3.4 Key Elements of Awareness Generation for Hospital Safety
An awareness programme on Hospital Safety shall aim at providing the basic information and
creatingtheenablingenvironmentsothatthelevelofacceptanceforhospitalsafetyisincreased
among the target group and an interest to know more is generated. The awareness strategy

Awareness Generation for Hospital Safety
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Hospital Safety
for hospital safety shall follow a top down approach, as the major decisions such as ensuring
structural safety through retrofitting of hospitals, non-structural safety, taking steps to sensitize
employees in various aspects of hospital safety are taken by the top management of hospitals.
The strategy shall be developed using multiple modes of communication and adopting a multi-
hazard approach. Involvement of all modes of communication such as electronic, print, IEC
materials, audio-visuals on disasters, dos and don’ts, standard operating procedures (SOPs)
shall be required to reach all segments of the target audience.
While developing messages for an awareness campaign on Hospital Safety, the following
elements shall be covered:
• There are many factors that put hospitals and health facilities at risk. These include –
buildings, their location and design specifications, patients – who are highly vulnerable
and during emergencies, the number of patients as well as their vulnerability increases.
Other than these, damage to hospital equipments and lack of basic lifeline services adds
to the risk.
• Components of a hospital or health facility are typically divided into two categories.
These are structural (design of buildings, resilience of material used etc.) and non-
structural (mechanical equipments, storage, shelves etc.) that determine the overall
safety of the health facilities.
• Functional collapse, not structural damage, is the usual reason for hospitals being
put out of service during emergencies. Elements that allow a hospital to operate on a
day-to-day basis are unable to perform during emergency. These include labs, operating
theatres, medical records, medical services, administrative process etc.
• Makingnewhospitalsandhealthfacilitiessaferfromdisastersisnotcostly.Incorporating
mitigation measures into the design and construction of new hospitals accounts for less
than 4 percent of the total investment.
• Makeshift/Temporary/Field hospitals are not necessarily the best solution to
compensate for the loss of a hospital or health facility, as these are not cost effective
• Seeking the right technical expertise to ensure that norms and building standards are
in place.
• Creating safe hospitals is as much about having vision and commitment as it is about
actual resources The responsibility of creating safe hospitals must be shared among
many sectors: planning, finance, public works, urban and land-use planning, together
with the health sector.

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3.5 Awareness Generation Exercises
For hospitals to be safe, awareness on disasters and its prevention is must. Information for
preparedness, mitigation and response shall be disseminated through various communication
modes packaged for different stakeholder groups. It shall be designed to address the specific
vulnerabilities of the area. Basic awareness and sensitization of the hospital staff consisting of
managerial and administrative staff besides doctors, nurses, para-medical staff is the primary
need for hospital safety.
Awareness generation on first aid, search rescue, trauma counselling, emergency exit
routes, fire safety, relevance of disaster management plans, handling emergencies, sanitation,
and safe construction are important for building a culture of safety in hospitals and it can be
directlytaken up bythehospital administration. Sensitization events,consultation/conferences,
mass media campaigns, public advertisements/messages shall be used to reach out to the
target audience. Special messages on radio, television and print media including journals for
doctors, health magazines may also be effective. Case studies documenting the examples
of other countries/states should be prepared and disseminated for creating greater public
awareness among professionals and related stakeholders. Awareness material such as signage,
hoardings, boards displayed in the health institutions such as hospitals (govt. and private),
local dispensaries, primary health centres, advertisements on ambulances etc. shall play an
important role in sensitisation and public awareness on the important issue of hospital safety
and risk management.
Education and Sensitization of medical professionals is the basic premise for risk reduction
in hospitals and other health facilities. This includes understanding disasters, its causes and
impacts, various phases of disasters and what actions are required to be taken and the critical
role that doctors play in the aftermath of disasters. Disaster Management especially with focus
on hospital safety and its various aspects need to be mainstreamed in the course curriculum
of medical and paramedical students.
Annexure 1 (Table 3.1 – Page 93) lists the Key communication approaches and specific activities
that can be used to reach out to key stakeholders.

Hospital Safety 11
4.1 Scope
This chapter focuses upon provisions required to be put in place to ensure functional safety of
hospitals/health facilities in disaster situations. The provisions stated herein are the minimum
required standards that shall be adhered to by all healthcare facilities; and address both internal
and external disasters that are likely to affect hospitals.
The prime objective of disaster preparedness and response for hospitals/healthcare institutions
is to ensure that they can remain functional and continue providing the necessary health care
services during and immediately after an emergency. To fulfill this objective, initiatives need
to be taken with regard to:
(1) Coordination Management
(2) Planning, Training and Drills
(3) Information and Communication
(4) Safety and Security
(5) Human Resources
(6) Logistics, Supply and Finance Management
(7) Continuity of Essential Services
(8) Triage
(9) Surge Capacity for Medical Response
(10) Post-disaster Recovery
(11) Patient Handling
(12) Volunteer Involvement and Management
(13) Area Level Networking of Hospitals
(14) Coordination and Collaboration with Wider Disaster Preparedness Initiatives
Hospital Disaster Preparedness
and Response
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Hospital Safety
EachhospitalshallhaveitsownHospitalDisasterManagementCommittee(HDMC)responsible
for developing a Hospital Disaster Management Plan (HDMP). Members of this committee
shall be trained to institute and implement the Hospital Incident Response System (HIRS) – for
both internal and external disasters.
4.2 Coordination Management
To enable effective preparedness and response during disasters, an efficiently functioning
HIRS (Hospital Incident Response System) shall be established in each hospital. The HIRS shall
be ingrained into practice, updated/revised and tested through repeated tabletop exercises
drills. The overall objective of the HIRS structure shall be to enable the development of
strategies,managementofresources,planningandimplementationofoperationsinemergency
situations.
All hospitals shall have a HIRS manual detailing but not limited to the:
(1) Command Structure: The HIRS Tree stating the positions and hierarchy with Job
action sheets
(2) Modular Organization: The emergency response structure shall be flexible so
that it can be expanded, and contracted depending on the type and size of the
incident.
(3) Consolidated Action Plans: of all the participating departments involved in
developing the overall incident objectives, selection of strategies, planning and
performance of tactical activities.
(4) Manageable Span of Control: The responsibility of each individual supervisor shall
be limited. The span of control will be from three to five persons, depending on
the type of incident, the nature of the response, the skill of the employee and the
distance involved.
(5) Comprehensive Resource Management: Stating clearly the expected resources
needed in a disaster their location in the unit/department.
To ensure effective Coordination and Management every hospital shall:
i. Establish an HIRS system to oversee operations, planning, logistics and finance/
administration required for disaster preparedness and response
ii. Define the functions of the HIRS System
iii. Define the roles and responsibilities of each member of the HIRS and other critical
hospital staff

Hospital Disaster Preparedness and Response
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Hospital Safety
iv. Develop job action sheets that briefly list the essential qualifications, duties and
resources required for HIRS members, hospital managers and staff for disaster
-response activities
v. Train all hospital staff and community members (including HIRS members) on the
structure and functions of the HIRS system so that each one is aware of their role
within the HIRS
vi. Designate a hospital management and coordination center
vii. Develop SOPs/strategies to implement the HIRS system
viii. Implement the HIRS action plan
4.3 Planning, Training and Drills
(a) Planning
The planning process shall broadly involve:
1. Formation of a sub-team (within the HDMC) who shall draft the plan.
2. Development of the plan and sub-plans; guidelines, standard operating procedures
etc.
3. Allocation of resources to execute the plans; and
4. Defining and allocating roles/responsibilities to be performed by hospital staff in
the event of activation of the plan.
The main objective of the Hospital Disaster Management Plan shall be to optimally prepare
the staff, institutional resources and structures of the hospital for effective performance in
different disaster situations. The HDMP shall be a written document and copies of the same
shall be made available to all staff in the hospital. It shall have comprehensive actionable
plans for disaster Preparedness, Response and Recovery corresponding to the Pre Disaster
Phase, Disaster Phase and Post Disaster Phase respectively. All hospitals shall have an HDMP
detailing but not limited to:
(1) Hazard Vulnerability Analysis (HVA) for the hospital/health facility
(2) Hospital Incident Response System
(3) Individual Roles and Responsibilities
(4) Hospital Capacity and Capability Analysis
(5) Hospital-Community Coordination, and
(6) Hospital Command Centre

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Hospital Safety
Adequate resource allocations shall be ensured for smooth implementation of the HDMP.
(Note: Most of the assessment, drafting, discussion and approval of the HDMP shall be done in the pre disaster
phase.)
(b) Training
AllhospitalstaffshallberegularlyorientedtotheHospitalDisasterManagementPlan(especially
each time the plan is updated or modified). Hospital staff who will implement the HDMP shall
be trained every alternate month.
All HIRS position holders (including their 2nd and 3rd line back-ups) shall learn the SOPs and
Job Action Sheets (JASs). They shall be trained as Master Trainers with a clear understanding
of the training outcomes in terms of examinations. Practice evaluations shall be documented
for inspection.
Specialized need-based trainings to perform specific functions during the disaster shall be
planned and executed for different categories of staff of the hospital. The training will follow
the matrix of skills appended in Annexure 2, 3 and 4.
Regular Training and capacity building provision shall be made to enhance the staff capacity
and competency in providing critical clinical services during emergencies.
(c) Drills
Everyhospital/healthcarefacilityshallconductperiodicdrillsandrehearsalstotesttheresponse
capabilitiestoemergenciesinrealtimewhichwillserveasopportunitiesforpracticallearningfor
the hospital staff.There are several types of hospital drills which include computer simulations,
tabletop exercises and operationalized drills involving specific emergency scenarios.
(1) Table Top Exercises
A Table Top Exercise is a paper drill intended to demonstrate the working and communication
relationships of functions found within the disaster management organizational plan and HIRS.
The exercise is intended primarily for the administrators, managers and personnel who could
conceivably be placed into an officer's position upon activation of the disaster management
plan. All hospitals shall carry out a table top exercise every quarter, with the full HIRS team.
Proceedings of the exercise shall be documented for inspection.
(2) Partial evacuation/Non-evacuation Drills Mass Casualty Incident (MCI) Response
Drills
Hospital evacuation may become a necessity if the hospital itself is damaged in a disaster. Such
situations need to be foreseen and proper planning has to go into how to evacuate and which

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areas of the hospitals need to be evacuated first in case of an internal disaster. All hospitals
shall do an ICU evacuation drill ward evacuation drill once a year.
The function of MCI drill is to check the resilience of the system in terms of capacity capability
when faced with an extraordinary surge of patients in the Emergency Room after an external
disaster. All hospitals shall carry out a MCI drill once a year.
All drills shall be evaluated by third party evaluators using a validated drill evaluation tool
documented. The learning from the hot wash after the drill shall be documented for inspection
and the HDMP shall be revised accordingly within 7 working days of completion of the drill.
To ensure proper planning, training and drills, every hospital shall:
i. Ensure that a Hazard- Vulnerability Assessment (HVA) of the hospital and a hospital
capability analysis precede the development of the Hospital Disaster Management
Plan
ii. Meticulously plan for each of the critical functions of hospital disaster preparedness
and response
iii. Develop standards/protocols/guidelines for all aspects of hospital disaster
preparedness and response
iv. Allocate adequate resources for the smooth execution of the Hospital Disaster
Management Plan
v. Regularly conduct trainings for the hospital staff involved in hospital disaster
preparedness and response
vi. Test the Hospital Disaster Management Plan by undertaking simulation exercises
vii. Conduct periodic Disaster Drills/exercises to improve the disaster preparedness
and the response capability of the hospital
viii. Regularly update and revise the Hospital Disaster Management Plan to meet the
changing and emerging scenarios.
4.4 Information, Communication and Documentation
(a) Information and Communication
TheHDMCshallensureclear,accurateandtimelycommunicationandinformationmanagement
(both internal and external) to ensure informed decision-making, effective collaboration and
cooperation, and public awareness through the use of common terminologies, integrated
communication and an efficient system of alert. These are clearly delineated in the HIRS

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Hospital Safety
guidelines and shall be followed. A Public Information Services/Media Cell shall also be
established.
The HIRS center shall communicate with the District Incident Response System other key
stakeholders like Police, Fire Services, DDMA/SDMA as well as other healthcare facilities
managing patients in the same catchment area by establishing a regular channel of
communication with them to manage the disaster more efficiently.
In case of a biological / epidemic emergency, the same shall be reported to the highest health
authorities at the earliest. Hospitals shall also report to appropriate agencies such as their
respective police departments, fire departments, DDMA, SDMA and NDMA.
(b) Documentation
All Medico-Legal Cases shall be recorded properly. However, the treatment of patients will
get priority over paperwork. To meet the surge of cases, additional medical records assistant/
technician shall be posted from the Medical records section. Computerised documentation
(or manual) will be beneficial for the staff, police, next of kin and the press. Details of the
casualties received and being admitted, their clinical condition, along with colour coordinated
classification status by Triage shall be documented, for a credible database, for efficient retrieval
of information to cater to any post-incident treatment/medico-legal/financial issues arising
at a later date.
To ensure effective information dissemination and a robust communication system every
hospital/healthcare facility shall:
i. Appoint/ designate a public information spokesperson to coordinate hospital
communication with the public, the media and the health authorities
ii. Establish an Information desk to provide the requisite information at regular
intervals and to serve as a hub for volunteer mobilization and management. The
list of casualties along with their status shall be displayed at a prominent place
outside the casualty / emergency ward, in both English and the local language,
which shall be periodically updated.
iii. Develop a robust communication protocol, including streamlined mechanisms for
information exchange between hospital administration, department heads and
facility staff
iv. Brief hospital staff about their roles and responsibilities during crisis situations
v. Establish mechanisms for timely information management and reporting to

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Hospital Safety
supervisory and other relevant stakeholders (neighboring hospitals, private
practitioners and pre-hospital networks etc.)
vi. Ensure availability of reliable and suitable primary and back-up communication
system( installation of suitable equipments depending upon the size, location and
critical units in the hospital which will get activated in times of emergency; select
staff to be trained on the usage of such equipments)
vii. Draft key messages for communicating effectively to the stakeholders (patient,
staff, public etc.) in preparation for the most likely disaster scenarios
viii. Maintain a database containing the contact information of all the hospital staff
and other relevant stakeholders update it periodically
Planning for communications (within and outside the hospital):
Communications is one of the main problems in major emergencies and disasters.
Information transfer has to be reduced to most important facts only. Multiple means
of communications should be planned to communicate with hospital staffs and
administrator.
The currently available communication networks which should be looked into for availability
in the hospital are;
_ internal telephone exchange (for the hospital)
_ landline phones
_ private mobile/cellular phones
_ mobile/cellular phones in closed user group (CUG) for hospital staffs only provided by
the hospital
_ Loudspeakers/ public address system
_ Wireless sets for security and ambulance personnel
_ The communications room
An area should be identified as communication room within the hospital and all internal and
external communications must be made from here. This communication room should be in
continuous contact with the command centre/control room.
All important numbers of hospital personnel, police, district functionaries of administration
other nearby hospitals etc. should be clearly mentioned in the HDMP and a copy of this Plan
should also be present in the communication room/ telephone exchange. Excerpts from
Guidelines on Hospital Preparedness and Planning – GOI – UNDP - 2008

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Hospital Safety
4.5 Safety and Security
Each hospital shall have Safety and Security Management protocols to describe the processes
designed to eliminate or reduce, to the extent possible, hazards in the physical environment
and to manage staff activities, to reduce the risk of injuries to individuals and loss of
properties. Safety and Security management protocols shall be applicable to all personnel,
physicians, departments and properties. The Safety and Security Management activities shall
be coordinated by the Hospital Disaster Management Committee (HDMC) in association with
all concerned stakeholders, internal and external.
To ensure adequate security and safety, every hospital/healthcare facility shall:
i. Appoint a hospital security team responsible for all hospital safety and security
activities
ii. Prioritize security needs of the hospital and identify areas where increased
vulnerability is anticipated
iii. Ensure early control of facility access points, triage, and other areas of patient
flow
iv. Establish reliable modes of identifying authorized hospital personnel, patients,
patients’ attendants and visitors
v. Establish mechanisms to escort medical personnel related to disaster relief to the
patient care areas when needed
vi. Define security measures required for safe and efficient hospital evacuation
vii. Define the rules for engagement in crowd control
viii. Solicit inputs from the hospital security team to identify potential safety and
securitychallengesandconstraints,includinggapsinthemanagementofhazardous
materials
ix. Solicit inputs from the hospital infection control committee regarding challenges
and constraints in prevention and control of hospital infection
x. Implement procedures to ensure the secure collection, storage and reporting of
confidential information
xi. Define the threshold and procedures for involving local law enforcement
xii. Establish an area for radioactive, biological and chemical decontamination and
isolation

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Hospital Safety
4.6 Human Resources
All hospital personnel shall be adequately prepared for emergencies and disasters. All hospitals
shall develop and implement a human resource management policy for the hospital for disaster
situationsto ensureadequatestaff capacityand thecontinuityofoperationsduringanyincident
that increases the demand for human resources.
All Hospital employees shall be classified as Essential or Non-essential as defined below:
(1) Essential (E): Employees whose job function is essential to clinical services or
operations during times of a natural or man-made disaster.
(2) Non-Essential (N): Employees whose presence is not essential during a declared
disaster event, but cannot leave until released by their supervisor and must return
to work as usual under routine operations after the disaster has been declared
over.
To effectively manage human resources every hospital/healthcare facility shall:
1. Establish and implement a human resource management policy for disaster
situations
2. Identify minimum needs in terms of health-care workers and other hospital staff to
ensure the operational sufficiency of the hospital/department in emergencies
3. Establish a contingency plan for provision of food, water and living space for hospital
personnel during disasters
4. Prioritize staffing requirements and resultant deployment
5. Recruit and train additional staff according to the anticipated need
6. Establish a clear policy to address the needs of ill or injured family members or
dependants of staff
7. Ensure adequate staff capacity and competency in providing high demand clinical
response services during emergencies by providing training and exercises
8. Ensure adequate shifts and rotation and self care of clinical staff as well as domestic
support measures to support staff to work for long hours
9. Ensure adequate capacity of the local community to facilitate hospital services during
emergencies
10. Ensure adequate measures to deal with psychosocial and mental health issues of
hospital staff and their families

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Hospital Safety
11. Establish an administrative mechanism for issuing authorization and rapid induction to
medical personnel who are not on the regular rolls to work in the hospital for enabling
capacity surges
12. Ensure that the personnel dealing with contagious diseases are provided with
appropriate Personal Protective Equipment (PPE) and interventions (eg. Vaccination)
in accordance with the policy and guidelines of the national health authority
4.7 Logistics, Supply and Finance Management
To ensure the continuity of the hospital supply and delivery chain, the following three main
functional areas shall be ensured:
(1) Operations: Responsible for the coordinated tactical response for the event/incident
(2) Logistics: Entails provision of facilities, services, and materials, including transportation
and fuel, shelter, personal hygiene, food, potable water, water for fire suppression,
medical attention and supplies, relief personnel etc.
(3) Finance/Administration: Includes tracking all event/incident related costs and evaluating
the financial considerations of the event/incident.
For efficient logistics, supply and financial management every hospital/healthcare facility
shall:
i. Develop and maintain an updated inventory of all equipment, supplies and
pharmaceuticals and establishment of a shortage-alert mechanism
ii. Estimate consumption of essential supplies and pharmaceuticals using most likely
disaster scenarios
iii. Consult with relevant authorities to ensure the continuous provision of essential
medicines and supplies
iv. Assess the quality of the contingency items prior to purchase
v. Establish contingency agreements with vendors to ensure the procurement
prompt delivery of equipment and supplies in a disaster situation
vi. Develop mechanisms for storage and stockpiling of additional supplies including
pharmaceuticals and ensure an uninterrupted cold chain
vii. Establish mechanisms for quick assessment of the functional status of different
equipment and prompt maintenance and repair of those equipment required for
essential services

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Hospital Safety
viii. Define the hospital pharmacy’s role in providing pharmaceuticals to patients being
treated at home or at alternate treatment sites
ix. Establish coordination for a contingency transport strategy for patient transfer
x. Establish a simple disaster budget protocol for quick mobilization of funds for
disaster response
xi. Ensure availability of petty cash/dedicated contingency fund which could be used
for disaster response
xii. Introduce special accounting policies and procedures for efficient financial
management during emergencies
 Safe disposal of Bio-medical waste as per The Bio-Medical Waste (Management
Handling Rules, 1998 which were notified under the Environment Protection Act,
1986 (29 of 1986) by the Ministry of Environment and Forest, Govt. of India on 20th
July, 1998. The guidelines have been prepared to enable each hospital to implement
the said Rules, by developing comprehensive plan for hospital waste management, in
term of segregation, collection, treatment, transportation and disposal of the hospital
waste
4.8 Continuity of Essential Support Services
Every hospital shall ensure the continuity of essential services in all the circumstances
by ensuring adequate resources and hospital supplies, developing and ensuring back up
arrangement of utility services, having a deployable evacuation plan, coordinating and
networking with neighboring hospitals/health care institutions that can facilitate in continuing
the essential services of the hospitals during the emergencies.
The Utility Systems Management plan and protocols shall be overseen by a Utilities
Subcommittee of the Hospital Disaster Management Committee and report related concerns
to that committee.
Every hospital shall also have a business continuity plan (BCP) that can be activated in
emergencies to facilitate in continuing essential/critical services of the hospital. The main
elements of a hospital BCP shall be as follows:
(1) plans and procedures for all readiness levels;
(2) essential business functions;
(3) succession of key leadership positions and delegations of authority for their
associated duties; safekeeping of vital records and resources;

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Hospital Safety
(4) identification of continuity facilities;
(5) a plan for interoperable and redundant communications;
(6) human resource planning;
(7) validation of the plan through testing, training and exercising activities;
(8) specify a plan for devolution of essential business functions; and
(9) provide a plan for reconstitution after the disaster.
A key aspect of continuity of essential support services is the structural design and safety of
the essential support service systems. The Utilities Sub-Committee shall refer to the section
3.5 of this guideline and implement the necessary provisions to ensure the continuity of
essential services.
To ensure the continuity of essential services every hospital/healthcare facility shall:
i. List and identify all hospital services and rank them in order of priority.
ii. Develop a utility management plan and protocols for the hospital, with clear
actionable mechanisms to ensure proper maintenance, 24x7 availability of the
routine/normal and emergency domestic and treated water systems, power
systems,medical gasandvacuumsystems,naturalgassystems,heating,ventilation
and air conditioning systems, elevators/lifts, fire/life safety systems.
iii. Identifytheresourcesneededtoensurethecontinuityofessentialhospitalservices,
in particularthoseforcriticallyill and othervulnerablegroups (e.g. pediatric,elderly
and disabled patients)
iv. Ensure the existence of a systematic and deployable evacuation plan that seeks
to safeguard the continuity of critical care
v. Coordinate with local health authorities, neighboring hospitals and private medical
practitioners to ensure continuous provision of essential medical services to the
community
vi. Ensure the availability of appropriate back-up arrangements for essential life lines
including water, power, food supplies, medical gases etc.
vii. Ensure the availability of adequate hospital supplies
viii. Ensure contingency mechanisms for hospital waste management

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Hospital Safety
4.9 Triage
Triage is the process of sorting injured people into groups based on the severity of their
conditions, so that the most serious cases can be treated first. Every hospital shall prioritize
patient treatment efficiently when resources are insufficient, by undertaking triage based on
the philosophy that ‘the sickest is seen first’. Patients shall be evaluated quickly for their vital
signs, chief complaint and other key indicators to be categorized as:
(1) Category I (obvious life-threatening emergency): The physician shall examine the
patient with zero delay. Case examples include cardiac arrest, continuous seizures,
acute severe chest pain, haematemesis, sudden loss of consciousness, major
trauma with hypotension, etc.
(2) Category II (Potential for life-threatening emergency): The possibility of an occult
or pending emergency condition. Although some of these patients initially may
appear to have not-so-serious chief complaints, about 25% of these patients have
high-risk conditions. The patient shall be fully evaluated and treated by a physician
within 10 minutes of arrival, since there could be potential instability to the vital
signs. Case examples include dyspnoea, high fever, acute abdominal pain, acute
confusion, severe pain, serious extremity injuries, large lacerations, etc.
(3) Category III (non-life-threatening emergency): These patients' presentation need
emergency care but provide no reason to consider the possibility of threat to life
or limb. These patients shall be seen by an Emergency Management physician on
a first-come first served basis in the Consultation Room. Case examples include
chronic, minor, or self-limiting disorders, medication refill, skin disorders, mild adult
upper respiratory tract symptoms, mild sore throat, blood pressure check, etc.
To undertake effective triage every hospital/healthcare facility shall:
i. Designate an experienced triage officer to oversee all triage operations
ii. Ensure that areas for receiving patients, as well as waiting areas, are effectively
covered, secure from potential environmental hazards and provided with adequate
work space, has adequate lighting and access to back up power
iii. Ensure that the triage area is in close proximity to essential personnel, medical
supplies and key care services and that entrances and exit routes to and from the
triage area are clearly identified
iv. Identify a contingency site for receipt and triage of mass-casualty victims and an
alternate waiting area for wounded patients who are able to walk

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Hospital Safety
v. Establishment of a mass-casualty triage protocol based on severity of illness/injury,
survivability and hospital capacity
vi. Establish a clear method of identification of triaged patients
vii. Ensure adequate supply of triage tags
viii. Ensure operationalization of protocols on hospital admission, discharge, referral
and access to operation theatres when the disaster plan is activated to facilitate
patient flow
4.10 Surge Capacity for Medical Response
Surge capacity is the ability of a health service to expand beyond normal capacity to meet
increased demand for clinical care. Every hospital shall calculate their surge capacity early in
the planning process such that the disaster response structure can be established, expanded,
and contracted depending on the type and size of the incident. The objective of planning for
surge capacity shall be to undertake the following activities during a disaster event:
(1) Conduct a situation assessment
(2) Collect, evaluate disseminate, and use information of the event/incident
(3) Develop information with regard to the hospital’s current status with respect to
the event/incident, to assist in the development of contingency plans (including
status of response efforts and resources)
The Hospital Capacity Analysis tool shall be used to calculate a hospital’s surge capacity by
determining:
(a) Hospital Treatment Capacity (HTC): defined as the number of casualties that can
be treated in the hospital in an hour and is usually calculated as 3% of the total
number of beds.
(b) Hospital Surgical Capacity (HSC): the number of seriously injured patients that
can be operated upon within a 12-hour period. It is usually calculated as.
HSC = Number of operation rooms x 7 x 0.25
12 hrs
(Note: The above standards are for a 1000 bedded tertiary hospital. Modifications shall be made based on the
bed strength and staff strength for individual hospitals. Hospitals shall device and calculate their own treatment
capacity based on their previous experiences.)

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Hospital Safety
To ensure that the estimated surge capacity is applicable in real-time scenarios, every
hospital/healthcare facility shall:
i. Estimate the expected increase in demand for hospital services and calculate the
maximum capacity required for the same
ii. Identify methods of expanding hospital inpatient/outpatient capacity
iii. Outsource care or shift non-critical patients to appropriate alternative sites to
increase the hospital’s capacity
iv. Designate care areas for patient overflow
v. Verify availability of vehicles and resources for patient transportation
vi. Establish mechanisms for inter-facility patient transfer
vii. Identify potential gaps in the provision of critical medical care and address the
same while coordinating with neighboring and network hospitals
viii. Identify sites that may be converted into additional patient care units
ix. Prioritize/cancel non-essential services when necessary
x. Adapt hospital admission and discharge criteria and prioritization of clinical
interventions according to the available treatment capacity and demand
xi. Designate a specific area that may be used as a temporary morgue and formulate
a contingency plan for ensuring required post mortem procedures
xii. Establish protocols for maintenance of a special disaster store/stock pile
xiii. Designate an official for information and communication with attending family
members
Additionally, the following resources shall be assessed and maintained to ensure effective
surge capacity management:
1) Manpower
2) Stores and equipment
3) Mortuary
4) Procedure for discharge/transfer of patients
5) Emergency blood bank
6) Dietary services
7) Mutual aid agreements for transfers and accommodation with network
hospitals

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Hospital Safety
4.11 Post-Disaster Recovery
Post-disaster recovery planning shall be part of the Hospital Disaster Management Planning
process and it shall be performed at the onset of response activities.
To ensure speedy and effective post-disaster recovery every hospital/healthcare facility
shall:
i. Designate an official/member of the staff to oversee the hospital recovery
operations
ii. Determine the essential criteria and processes to deactivate the disaster response
and recovery activities from the hospital’s normal operations
iii. Undertake a Post Disaster Damage Assessment if there is structural damage to the
hospital
iv. Estimate the time and resources that shall be required to undertake complete
repair/replacement/retrofitting before a facility that is severely damaged (and
requires complete evacuation) can be re-opened
v. Undertake a post-response hospital inventory assessment and consider repair or
replacement of equipment as required (equipment venders could be involved in
assessing the functional status of the sophisticated equipment)
vi. Prepare and submit a post-response report to the chief of the hospital and other
pertinent stakeholders
vii. Debrief staff meticulously immediately after the disaster response phase to enable
them to cope and recover from any post traumatic stress disorder.
viii. Appropriately recognize the services provided by staff, volunteers, external
personnel and donors during disaster response and recovery
ix. Monitor post disaster health situation in the local community
x. Systematically and comprehensively document lessons learnt and structural
modification/adaptation of the hospital contingency plan as required
xi. Ensure that the transportation of casualties is undertaken as per the provisions
laid down in the HDMP or as per the appropriately modified provisions
xii. Provide definitive treatment
4.12 Patient Handling
Patients in a hospital can be categorised as:

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Hospital Safety
(1) ambulatory (outpatients), and
(2) admitted patients (inpatients).
The mobility of inpatients depends on the severity of their illness, such that:
i) Seriously ill patients depending completely on life support systems, cannot move by
themselves and need support of the health care workers/hospital staff to move
ii) Not seriously ill patients but those restricted by IV lines, nebulizers etc. need
support from their attendants to move, and
iii) Not seriously ill patients, require no support and can move by themselves.
To avoid panic, chaos, hap-hazard evacuation (should it be required), avoidable injuries and
loss of lives, hospitals shall sensitize patients and their attendants on the relevant aspects of
the HDMP and their role at the time of a disaster event, during their stay in the hospital.
Patients, their attendants and visitors shall be made aware of:
(1) Hazards and Risks: In and around the hospital through prominently displayed
posters, wall hangings and hoardings. The posters, wall hangings and hoardings
shall be permanent and displayed at all times in the hospital premises and shall
be updated as necessary.
(2) Emergency Exit Routes and Evacuation Plans: To be followed during disasters
through the prominent display of exit and evacuation route maps at strategic
locations throughout the hospital premises.
Hospitals shall also ensure that their alarms, emergency communication and Hospital Safety
and Security Procedures, adequately take into consideration the needs of patients, their
attendants and visitors; and ensure that no panic and chaos is initiated.
4.13 Volunteer Involvement and Management
Local volunteers in close proximity to hospitals/health care facilities shall be involved by the
hospital authorities for hospital disaster preparedness and response.
Volunteers shall be identified in the pre-disaster phase itself and an updated roster with key
information (like contact details, address, etc.) shall be maintained by the appropriate authority
in the hospital. Volunteers shall be trained in:
(1) Basic emergency preparedness and response
(2) Search and Rescue
(3) First Aid

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Hospital Safety
(4) Basic Life Support
(5) Community Triage
(6) Health Communication / Psychosocial Care
(7) Inter-personal Communication and Leadership
Volunteers shall be involved in all preparedness activities from the pre-disaster phase itself
and shall participate each time the hospital undertakes a drill, preparedness exercise, training,
etc. on Disaster Preparedness and Response.
4.14 Area Level Networking of Hospitals
To respond to a scenario when the hospital’s surge capacity has been exceeded by the number
of patients requiring medical attention, every hospital shall network with other hospitals in
the area so that patients may be transferred to the nearest equipped hospital for treatment
without any delay. Hospitals shall define the arrangements/memorandum of understandings
between them and the networked hospitals during the pre-disaster phase itself, for such
eventualities. A list of all networked hospitals (along with their capacity, speciality) shall be
maintained and updated regularly by the appropriate authority in the hospital.
Patients shall be transferred to a networked hospital only after immediate/life-threatening
injuries are addressed. The mode of transport to be used shall be determined according to the
patient’s needs and the available resources. A volunteer or hospital staff shall accompany the
patient to the referral hospital to ensure proper handing over to the competent authority.
4.15 Coordination and Collaboration with Wider Disaster Preparedness
Initiatives
Hospitals the facilities they provide are critical to a community’s coping capacity during
emergencies/disasters. Therefore, hospitals shall coordinate and collaborate with various
health sector and general disaster management preparedness and response initiatives to
enhance their own disaster preparedness and response readiness. Hospitals shall make efforts
to integrate into the district disaster management plan and disaster response activities; as well
as incorporate into their own HDMP relevant elements of the district disaster management plan
and the district’s planned response activities to be in rhythm with larger disaster management
goals of the district/state/country. Further, hospitals shall comply with various Acts, Standards,
Regulations and development programmes pertinent to hospitals in the country.

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Hospital Safety
4.16 Hospital Disaster Management Plan with respect to CBRN
Emergencies:
The National Disaster Management Guidelines on Medical Preparedness and Response
mention that the State Disaster Management Plan will identify and earmark certain hospitals
for development of specialized facilities for the management of CBRN casualties. Dedicated
staff of all these hospitals will be trained to use PPE and other universal safety precautions laid
down in the plan. CBRN management will begin with the decontamination and decorporation
followedbyimmediateandlongtermmedicaltreatmentofcasualties.Theidentifiedhospitals
will create specialized facilities for detection, decontamination, decorporation, treatment
(Refer : Point 6.7(page66-68) of the NDM Guidelines on Medical Preparedness and Mass
Casualty Management.
Further the guidelines also mention that specified hospitals for CBRN Treatment will stock all
the drugs, decorporation agents and other specialized items for treatment of CBRN casualties
(Refer Section on CBRN Stores –Page 68-69 of the NDM Guidelines on Medical Preparedness
and mass casualty management)

Hospital Safety 31
5.1 Scope
Specifications laid down in this Chapter shall be applicable for:
(a) Planning, design and construction of New Hospitals; and
(b) Re-planning, assessment and retrofitting of Existing Hospitals.
When provisions given in this Chapter conflict with those given in relevant national standards
and guidelines (meant for safety of hospitals in India), specifications given in this Chapter shall
govern.
Specifications given in this Chapter are intended for
(a) Structural Elements (SEs)
These are components of buildings, which resist loads imposed by external load effects, and
support all Non-Structural Elements (NSEs) and imposed loads on floors and roof slabs; and
(b) Non-Structural Elements (NSEs)
Thesearecomponents of buildings,which DO NOT resist loads imposed byexternal load effects,
but are supported by SEs of buildings; they fulfil the necessary architectural and functional
requirements.
These specifications address all load effects likely to act on Hospital Buildings (including Blasts,
Cyclones and Earthquakes).
Four aspects shall be addressed to ensure safety of SEs and NSEs of Hospital Buildings:
(1) In New Buildings
(i) Structural Design and Construction.
(2) In Existing Buildings
(i) Pre-Disaster Safety Assessment,
(ii) Retrofitting, and
Design and Safety of
Hospital Buildings
5

32
Hospital Safety
(iii) Post-Disaster Damage Assessment.
To undertake the above activities, documents are required to assist architects and designers,
based on sound scientific principles and best practices worldwide. Tables 3.1 and 3.2 indicate
the status of availability of documents. Documents presently not available shall be developed
through a nationally coordinated effort.
Table 5.1: Applicable Standards for ensuring Safety of Structural Systems and Structural
Elements (SEs) of Hospital Buildings
S.No. Standard or Guideline Comment
1 StructuralDesignofNew
Hospitals
This Guideline addresses additional requirements for
DESIGN of SEs (over and above those prescribed by
relevant national standards), but does NOT provide
specifications for DETAILING of SEs and connections
between SEs.
Detailed clauses and commentaries need to be developed
specifically for structural design.
2 Pre-Disaster Structural
Safety Assessment of
Existing Hospitals
Basic IS code is available for masonry and RC
structures.
Detailed documents need to be developed, which shall
comply with the requirements laid down in this Chapter
also.
3 Structural Design of
Retrofit of Existing
Hospitals
Currently, no standard is available.
also.
4 Post-Disaster Structural
Damage Assessment of
Existing Hospitals
also.

Design and Safety of Hospital Buildings
33
Hospital Safety
Table 5.2: Applicable Standards for ensuring Safety of Non-Structural Elements (NSEs) of
buildings
S.No. Standard or Guideline Comment
1 Design of NSEs of New
Hospitals
This Guideline addresses additional DESIGN
requirements (over and above those prescribed by
relevant national standards), but does NOT provide
specifications for DETAILING of connections between
structural and non-structural members.
Detailedclausesandcommentariesneedtobedeveloped
on design and detailing of connection between SEs and
NSEs.
2 Pre-Disaster Safety
Assessment of NSEs
Currently, no formal standard is available.
also.
3 Design of Retrofit of Non-
Structural Systems and
Elements in Hospitals
This Guideline addresses the additional
requirements.
also.
4 Post-Disaster Damage
Assessment of NSEs
also.
Note: Basic guidance on these four aspects is available in some national and international
documents [e.g., ‘Reducing Earthquake Risk in Hospitals from Equipment, Contents,
Architectural Elements and Building Utility Systems.’ Geo-Hazards International. 2009].
5.2 Expected Performance Of Hospitals
Building Units of a Hospital Campus shall be classified under two groups, namely,
a. Critical Units of Hospital Buildings – Buildings and Structures (and therefore SEs and
NSEs) that provide medical services essential in the immediate aftermath of disasters ;
and

34
Hospital Safety
b. Other Units of Hospital Buildings – Buildings and Structures (and therefore SEs and NSEs)
that provide all the other services that may not be required in the immediate aftermath
of disasters.
The expected performance is different for each of these two groups of hospital buildings.
The Critical Units shall comply also with specifications laid down in this Chapter in addition
to specifications laid down in the prevalent relevant national standards; the Other Units shall
comply with the specifications laid down in the prevalent relevant national standards.
5.2.1 Performance Criteria
Under loads actions other than earthquakes for all units of the Hospital Building, no damage
is permitted in SEs. But, under the action of earthquake effects, two cases arise for SEs:
(1) Critical Units – structural damage commensurate with Immediate Occupancy (IO)
performance level is permitted;
(2) Other Units – structural damage commensurate with Life Safety (LS) performance level
is permitted.
The definitions of IO and LS performance levels are:
a. ImmediateOccupancy:StructuralSystemsandStructuralElements(SEs)sustainfinecracks
and undergo marginal nonlinear actions that pose no threat to the people conducting
within the hospital and the activities to be undertaken in the hospital thereby allowing
the structure to be occupiable immediately after the expected load effects are removed;
and
b. Life Safety- SEs sustain reasonable structural damage, but do not lead to structural
collapse.
Similarly, under loads actions other than earthquakes for all units of the Hospital Building, no
damage is permitted in NSEs. But, under the action of earthquake effects, two cases arise for
NSEs:
(1) Critical Units – damage commensurate with Immediate Use (IU) performance level is
permitted;
(2) Other Units – damage commensurate with Dysfunctional State (DS) performance level
is permitted.
The definitions of IU and DS performance levels are:
a. Immediate Use: Non-Structural Elements (NSEs) sustain no damage and undergo elastic
actions that pose no threat to the use of the NSEs and the service to be provided by it

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Hospital Safety
thereby allowing the NSEs to be usable immediately after the expected load effects are
removed; and
b. Dysfunctional State – NSEs sustain reasonable damage that renders it temporarily out
of use, but that is repairable but do not lead to structural collapse.
5.2.2 Load Levels
Critical Units of hospital buildings and structures shall be designed to resist all expected loads
given by
a. Prevalent relevant national standards, and
b. Additional specifications laid down in this Chapter.
Extreme load actions are caused by blasts, cyclones and earthquakes. Site-specific studies shall
be undertaken to estimate the hazard level for these extreme actions for all hospitals with high
risk; the level of risk will be determined by the competent authority considering level of hazard,
occupancy, importance and criticality of services to be rendered by the health facility.
5.3 Design Standards
Structural Elements (SEs) of all Critical Units of the new Health Facilities shall comply with
requirements of this Chapter in addition to all relevant existing national standards and
guidelines laid down by various statutory bodies, non-statutory bodies as well as client owner
of health facility. The other Units of the new health facilities shall comply with requirements of
all relevant existing national standards and guidelines laid down by various statutory bodies,
non-statutory bodies as well as client owner of health facility. The latest versions of national
documents currently in use are:
a. New Hospitals: NBC, IS:875, IS:1893(1), IS:1893(4)( for pipelines), IS:456, IS:800, IS:13920,
GSDMA Guidelines, and IPHS, and
b. Existing Hospitals: NBC 2007, IS:875, IS:1893(1), IS:456, IS:800, IS:1905, IS:13920,
IS:13935, IS:15988, and GSDMA Guidelines.
5.4 Structural Elements
Higher levels of engineering shall be adopted in the planning, design, construction and
maintenance of Critical Units of Hospital Buildings; this will require engineers to be examined
for their competency before being empowered to work in projects related to health facilities.
Hence, the extreme load effects for which Critical Units of Hospital Buildings shall be designed

36
Hospital Safety
are higher specifications than those for which the Other Units of Hospital Buildings are required
to be designed. These higher specifications are given in this section beyond those specified in
the relevant national standards.
5.4.1 New Health Facilities
A new health facility means
(1) A new construction, and
(2) A reconstruction of an existing facility at the same site or new site.
(a) Site Selection
The following sites shall be prohibited for locating a hospital:
i. Liquefiable ground;
ii. Hill slopes (unstable), or land adjoining hill slopes known to have rolling debris; (whether
sloped or flat)
iii. Flood or tsunami prone areas;
iv. Adjoining unsafe buildings and structures; and
v. Poor accessibility in post-disaster situations.
Local municipal bodies shall undertake to assess these vulnerable areas and inform the
stakeholders of the same.
When existing hospitals are located in any of these vulnerable locations, no future expansions
shall be permitted in the hospital campuses. Also, critical assessment shall be undertaken to
study the risks involved and appropriate actions shall be taken either to mitigate the effects or
relocate the hospital. When new towns or layouts are being planned, the master plan of the
same shall take cognisance of the prevalent vulnerabilities before determining the location
of new hospitals.
(b) Structural Systems
(i) Material
Thebasicmaterialfortheconstructionofthestructuralsystem(andStructuralElements)ofnew
hospital buildings shall NOT be unreinforced masonry. Structural Elements of all new hospital
structures shall be made of Reinforced Concrete and/or Structural Steel, except for structures
in seismic zone II, where Reinforced Masonry may be used. Design codes need to be developed
fordesign and construction of Reinforced Masonry,and associated capacitydevelopmentneeds
to be undertaken alongside of architects, engineers, contractors and masons.

37
Hospital Safety
(ii) Use of Structural Walls
The structural system of new hospital buildings shall NOT be Moment Resisting Frames alone
along any of the two mutually perpendicular plan directions of the building; structural system of
all new hospital buildings shall have Structural Walls in each of the two mutually perpendicular
plan directions of the building in addition to Moment Resisting Frames.
1. The structural system of Moment Resisting Frames with Structural Walls shall be designed
as a DUAL SYSTEM (as defined in IS:1893 (Part 1).
2. The Structural Walls shall be made of Reinforced Concrete (RC) and provided in select
bays running through the full height of the building, irrespective of choice of material
of the basic structural system adopted for the hospital, namely RC or Structural Steel.
3. Structural walls made of steel plates or timber may be allowed in the construction of
Hospitals only in Seismic Zone II. Even then, safety of such hospital buildings with steel
plate or timber Structural Walls shall be established by:
a. Analytical Methods, through nonlinear pushover analyses and nonlinear time
history analyses under a suite of appropriate ground motions, and
b. Full-scale experimental testing of such structural walls and sub-assemblages
including them being subjected to deformations imposed on them during expected
ground motions.
4. The total cross-sectional area of all RC Structural Walls shall be at least 4% of the plinth
area of the building (if that based on design is smaller than 4%), along each of the two
mutually perpendicular principal plan directions.
5. RC Structural Walls shall be designed in accordance with IS:13920 or specialist literature
more stringent than IS:13920.
6. When RC Structural Walls are rested on individual strip footings, the large lateral
overturning moments and lateral shear force induced under the action of extreme load
effects shall be resisted by positive strategies. The bottom raft of the strip footings shall
be anchored to rocky strata when underlying ground strata has hard rock, and to pile
foundations when underlying ground strata is soft soil. This may not be a concern when
RC walls are rested on Mat foundations.
7. At each joint of Moment Resisting Frames, the design moment capacity of column section
shall be at least 2 times design moment capacity of beam section.

38
Hospital Safety
(iii) Base Isolation Systems
Base Isolation System is an expensive technology option though effective to counter ill effects
of strong earthquake shaking in new hospital buildings. Hence, Base Isolation System may be
adopted in important hospitals in seismic zones IV and V. But, this system can help in minimising
effects of earthquake shaking on NSEs. When the client owner insists on using such a system,
it shall be adopted only when safety of such hospital buildings is established by
1. Analytical Methods, through nonlinear pushover analyses and nonlinear time history
analyses under a suite of appropriate earthquake ground motions, and
2. Full-scale experimental testing of base isolation devices demonstrating that they are
capable of resisting expected strong earthquake shaking.
(iv) Prohibited Structural Systems
The following structural systems shall be prohibited for use in new hospitals:
1. Flat Slab buildings, with or without structural walls ;
2. Pre-stressed floor systems;
3. Precast constructions (with natural or man-made materials), in part or whole of the
structure, and
4. Pre-engineered structures in part of the whole of the structure
5. Large cantilever structures and long span structures
6. Unreinforced masonry buildings
(c) Structural Configuration
(i) Regular Structural Configurations
All new hospital buildings shall have regular structural configuration only. Buildings shall be
deemed to be regular when they meet requirements laid out in Clause 7.1 of the Indian Seismic
Code IS:1893 (Part 1). Floating and setback columns shall not be allowed in buildings.
(ii) Structural Configurations Prohibited
Structural configurations with open ground storeys or flexible or weak storeys at any other
level shall be prohibited in hospital buildings.
(d) Structural Analysis
Soil-Foundation System
The 3D modeling and analyses of Critical Units of Hospital Buildings shall include:

39
Hospital Safety
(i) Flexibility of soil strata underneath the building, based on results of geotechnical studies
at the sites; and
(ii) Possible uplift actions at individual footings under the action of extreme load effects.
Effect of URM Infills
Multiple 3D models shall be considered in the analyses of Critical Units of Hospital Buildings
to account for detrimental effects of stiffness and strength contributions of unreliable URM
infills. In the design of SEs and NSEs, these models shall estimate the effects on strength and
deformation demands of these Critical Units of Hospital Buildings.
(e) Structural Design
SEs of Critical Units of Hospital Buildings shall be designed to resist elastically the expected
load actions on them, including those due to earthquake effects. Hence, the design lateral
earthquake forces prescribed in this guideline are much larger than those currently employed
in design of buildings (including hospitals), to meet the requirement of immediate use of the
hospital building structure and fully functional performance of the NSEs within the hospital
building. Here, “designed to resist elastically” shall imply that the stress-resultant demands
(namely P, V, M and T) on each structural element is less than its associated nominal capacities
(as defined by IS:456 and IS:800 for structural elements made of RC and Structural Steel,
respectively).
The design horizontal acceleration coefficient Ah
given in Clause 6.4.2 of IS:1893(1)-2002 for
design of SEs shall be replaced by:










g
S
R
ZI
A a
h
where, Z is the Seismic Zone Factor, I the Importance Factor, the Design Acceleration Spectrum
for three different soil conditions, and the Response Reduction Factor, all as defined in
IS:1893(1)-2002.
Effects of vertical earthquake ground shaking also shall be considered in the design of SEs.
5.4.2 Existing Health Facilities
An existing health facility means
(1) All existing health facilities that do not meet the standards mentioned in this
guideline,
(2) A reconstruction of an existing facility at the same site or new site, and

40
Hospital Safety
(3) An existing commercial, office or residential buildings designed and built for other
functional use, but now intended to be used as a hospital facility.
The number of existing hospital buildings is large, which require seismic retrofitting to meet
specifications for earthquake safety laid down in this Chapter. Upgrading this large number of
existing hospital buildings is a daunting task.
(a) Building Configuration
The building structure of retrofitted hospitals shall meet the criterion specified in this
section.
(i) Originally REGULAR Buildings
Buildings shall be deemed to be REGULAR when they meet requirements laid out in the current
Indian Seismic Code IS:1893 (Part 1)-2002). The building structure of the retrofitted REGULAR
buildings shall meet the following criterion under the shaking specified in Section 5.4.2(b) of
this document:
(1) Linear structural analysis shall be performed for seismic safety assessment of
retrofitted Regular Buildings, to assess (i) the stress resultant demands (of axial
load, shear forces and bending moments) on different structural elements in the
existing building, and (ii) the lateral drift demand on the different storeys of the
building.
(2) These stress resultants demands imposed by the level of shaking considered shall
not exceed the design capacity of any structural element of the existing building
with the considered retrofit scheme.
(3) The storey lateral drift demand in the existing building shall not exceed 0.4% of the
heightofthestoreyusingun-cracked section properties. Thisoverall deflection shall
be arrived at by linear analysis of the structure considering all competent masonry
and reinforced concrete elements. For this analysis, material properties shall be
taken as per the relevant Indian Standard Codes, namely IS:456 and IS:13920
for reinforced concrete frame buildings and IS:1905 for masonry buildings. If all
attempts fail to collect relevant field data for the buildings, lower boundary values
for the existing materials may be used. Further, all strength/stress requirements
shall be met with as laid out for structural components of the buildings in the said
and other relevant Indian Standard Codes.

41
Hospital Safety
(ii) Originally IRREGULAR Buildings
Buildings shall be deemed to be IRREGULAR when they conform to the clauses laid out in the
current Indian Seismic Code IS:1893 (Part 1)-2002. The building structure of the retrofitted
IRREGULAR buildings shall meet the following criterion under the shaking specified in Section
5.4.2(b) of this document:
(1) Structural analysis shall be performed as given in IS:13935 or IS:15988 for seismic
safety assessment of retrofitted Regular Buildings, to assess (i) the stress resultant
demands (of axial load, shear forces and bending moments) on different structural
elements in the existing building, and (ii) the lateral drift demand on the different
storeys of the building.
(2) These stress resultants demands imposed by the level of shaking considered shall
not exceed the design capacity of any structural element of the existing building
with the considered retrofit scheme.
(3) The storey lateral drift demand in the existing building shall not exceed 0.35%
of the height of the building using un-cracked section properties. This overall
deflection shall be arrived at by linear analysis of the structure considering all
competent masonry and reinforced concrete elements. For this analysis, material
properties shall be taken as per the relevant Indian Standard Codes, namely IS:456
and IS:13920 for reinforced concrete frame buildings and IS:1905 for masonry
buildings. If all attempts fail to collect relevant field data for the buildings, lower
boundary values for the existing materials may be used. Further, all strength/
stress requirements shall be met with as laid out for structural components of the
buildings in the said and other relevant Indian Standard Codes.
Level of Earthquake Shaking to be considered
Making existing Critical Units of Hospital Buildings meet requirements laid down for new
hospitals in this Guideline can be difficult – it can be too stringent to meet the specifications
corresponding to new buildings, or even too expensive to do so. When existing deficient Critical
Units of Hospital Buildings are to be retrofitted, they shall be designed to resist the effects of
earthquake shaking given by the design horizontal acceleration coefficient Ah
given in Clause
6.4.2 of IS:1893(1)-2002 for design of SEs given by:










g
S
R
ZI
A a
h
2

42
Hospital Safety
where, Z is the Seismic Zone Factor, I the Importance Factor, Sa
/g the Design Acceleration
Spectrum for three different soil conditions, and R the Response Reduction Factor, all as
defined in IS:1893(1)-2002.
(c) Structural Design
Critical Units of existing hospital buildings shall be improved so that their Structural Elements
resist the expected load actions on them without significant damage under the action of load
actions other than earthquakes, and structural damage such that it does not lead to collapse
under the action of earthquake effects.
The Critical Units of existing masonry or RC Hospital Buildings shall be assessed by analytical
methods specified in IS:13935 or IS:15988, respectively.
5.5 Non-Structural Elements
The Non-Structural Elements (NSEs) of all New Hospitals and NSEs of all Existing Hospitals shall
comply with all relevant existing national standards and guidelines as laid down by the various
statutory and non-statutory bodies as well as the client owner of the hospital. In addition,
specifications laid down in this Chapter shall be applicable for
a. Planning, design and construction of NSEs of New Hospitals, and
b. Re-planning, assessment and retrofitting of NSEs of Existing Hospitals.
The specifications laid down in this Chapter shall govern over similar clauses given in the
prevalent relevant national standards.
5.5.1 Design Strategy
NSEs shall be classified into three types depending on their earthquake behaviour, namely:
a. Acceleration-sensitive NSEs: The lateral inertia forces generated in these NSEs during
earthquake shaking cause their sliding or toppling to the level of their base or lower.
b. Deformation-sensitive NSEs: The relative lateral deformation in these NSE spanning
between two SEs (e.g., a pipeline passing between two parts of a building with a
separation joint in between) or between an SE and a point outside building (e.g., an
electric cable between the building and ground/pole outside the building), causes them
move or swing by large amounts in translation and rotation under inelastic deformations
of SEs imposed on them during earthquake shaking; and
c. Acceleration-and-Deformation-sensitive NSEs: Both of the conditions described in (a)
and (b) above are valid.

43
Hospital Safety
Table 3.3 provides a list of NSEs and identifies if the NSE is acceleration-sensitive or deformation
sensitive. Some NSEs fall under both categories, with one of the effects being the more
dominant (called primary effect) and the other less dominant (called secondary effect). For such
NSEs, Table 3.3 identifies both the primary and secondary effects for design of the connection
between the NSE and the SE. All NSEs in new hospitals shall be protected against the effects
mentioned above. Positive systems are required to either anchor or release the restraint at
the ends (depending whether the NSE is acceleration-sensitive or displacement-sensitive,
respectively) to ensure there is no damage to NSEs.
Table 5.3: Categorisation of commonly used NSEs based on earthquake behaviour
Category Sub-category Non-Structural Element Sensitivity
Acceleration Deformation Both
C o n s u m e r
Goods inside
buildings
Furniture and
minor items
1. Storage shelves
2.
Multi-level material
stacks

Appliances 1. Refrigerators
2. Washing machines
3. Gas cylinders
4. TVs
5. Diesel generators
6. Water pumps (small)
7. Window ACs
8. Wall mounted ACs

Architectural
finishesinside
buildings
Openings 1. Doors and windows
2.
Large-panel glass
panes with frames
(as windows or infill
walling material)
3. Other partitions
Secondary Primary 
False ceilings Directly stuck to or hung
from roof

Suspended integrated
ceiling system
Stairs Secondary Primary 

44
Hospital Safety
Architectural
finishesinside
buildings
E x t e r i o r
or Interior
Façade
Tiles (ceramic, stone,
glass or other)
(i) pasted on surface
(ii) bolted to surface
(iii)
hung from hooks
bolted to surface
Not Permitted
Partitions not
held snugly
b e t w e e n
lateral load
r e s i s t i n g
members
Primary Secondary 
Appendages
to buildings
Vertical
projections
1. Chimneys and Stacks
2. Parapets
3. Water Tanks (small)
4.
Hoardings anchored
on roof tops
5.
A n t e n n a s
c o m m u n i c a t i o n
towers on rooftops
6.
Solar Panels on walls
or rooftops

H o r i zo nta l
projections
1. Sunshades
2.
C a n o p i e s a n d
Marquees

Hoardings anchored to
vertical face
Exterior
Structural
Glazing
Systems

45
Hospital Safety
Services and
Utilities
From within
a n d f r o m
outside to
inside the
building
1.
Water supply
pipelines
2.
Electricity cables
wires
3. Gas pipelines
4. Sewage pipelines
5.
Telecommunication
wires
6.
Rainwater drain pipes
7. Elevators
8. Fire hydrant systems
9. Air-conditioning ducts

Inside the
building
1.
Pipes carrying
pressurized fluids
2.
Fire hydrant piping
system
3.
Other fluid pipe
systems
S t o r a g e
V e s s e l s
and Water
Heaters
1.
Flatbottomcontainers
and vessels
2.
StructurallySupported
Vessels

Mechanical
Equipment
1. Boilers and Furnaces
2.
General
manufacturing and
process machinery
3. HVAC Equipment


46
Hospital Safety
Medical
Equipment
Sensitive 1. Ventilator 
2. Boyles Apparatus 
3. Bedside Monitors 
4. Defibrillator 
5.
Peritoneal Dialysis
Machine

6.
I n f a n t R a d i a n t
Warmer

7. Phototherapy unit 
8. Operating Microscope 
Special 1. Colour Doppler 
2. Endoscopes 
3.
Slit lamp with
Applanation
Tonometer

4.
Portable X-Ray
machine

5. ECG machine 
6. Ultrasound machine 
7. Oxygen Concentrator 
8.
Automatic Cell
counter

Generic 1. CT Scan machine 
2. Centrifuge machine 
3.
Blood Bank
refrigerators

4. Deep freezer 
5. Operating Table 
6. EEG machine 
7. Blood Cell Separator 
8.
Impedance
Audiometer

9. Autoclave 

47
Hospital Safety
5.5.2 Non-Structural Systems
(a) Non-Structural Elements Prohibited
The following systems shall be prohibited for use as NSEs and its connections to the SEs in
new hospitals:
i. False ceilings hung from soffit of RC roof or floor slabs with anchor fasteners
embedded in concrete portion of RC slabs; when false ceilings are required from
medical safety point of view, exceptions shall be allowed subject to requirements
given below;
ii. Tiles pasted on unreinforced load-bearing masonry walls, unreinforced masonry
infill walls, or RC walls,
iii. Glass façade made of stone, ceramic, glass, etc.; when glass facades are required
from medical safety point of view, exceptions shall be allowed subject to
requirements given below; and
iv. Any NSE nailed to or supported by the Unreinforced Masonry Infill walls made of
any material.
False Ceilings
a. False ceilings shall be used only sparingly in hospital buildings.
b. When the client owner of the hospital insists on providing false ceiling in specific rooms
from the point of view of medical safety, the following shall be ensured:
(1) The false ceiling system shall be a formal system that is supported from the
reinforcement bars of the RC roof slabs or the structural system of the building to
counter the effects of strong earthquake shaking,
(2) No false ceiling shall be anchored to or supported by unreinforced masonry walls.
(3) When false ceilings cannot be supported by the roof or the vertical elements of
the structural systems, they shall be supported by an independent system that
is supported on the floor slab, but not interfering with the lateral load resisting
system.
Structural Glazing
When the client owner of the hospital insists on using structural glazing, such systems shall
meet the requirements of this Guideline, and safety compliance shall be established by:
a. Analytical Methods, through nonlinear pushover analyses and nonlinear time history
analyses under a suite of appropriate strong ground motions; and

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